Katia Smith
Columbus,OH
Summary
Claims Specialist with proven experience investigating and resolving property, health and business claims. Delivers professional and balanced customer service and meets needs of insured, claimant and internal and external customers. Insurance expert with exceptional knowledge of legal liabilities and claims practices and superior interpersonal skills.
Overview
7
7
years of professional experience
Work History
Customer Service Representative
HKT Teleservices
Dublin, Ohio
11.2016 - 03.2017
- Answered an average of 100 calls per day by addressing customer inquiries, solving problems and provided new product information
- Described product to customers and accurately explained details and care of merchandise
- Communicated with vendors regarding back order availability, future inventory and special orders
- Answered product questions with up-to-date knowledge of sales and store promotions
Data Migration Specialist
ComResource
Whitehall , Ohio
01.2018 - 05.2018
- Worked with Vendors to plan testing and auditing of accounts/files
- Plan, implement and manage the movement of data between IT systems and software
- Met with clients and vendors to find out their data migration needs
- Find and fix any outstanding faults or issues with migrated data
- Created a project plan for the migration process, including mapping risks and potential impacts
Service Center Representative
Sedgwick
New Albany, Ohio
04.2018 - 11.2018
- Educated and informed customers with multiple communication channels about documentation required to process a health claim, required time frames, payment information, and claim status
- Educated claimants/callers on client requirements and benefit plans documenting all required details of the call in a concise professional manner
- Entered verbal and written application information that meets both the internal and external customer's requirements accurately into the claims management system
Health Claims Assistant
Sedgwick
Worthington, OH
11.2018 - 06.2019
- Conducted research, contacted patients, and the local affiliates to include VA, Hospitals, and insurance carriers
- Submitted electronic and hard copy billing and conducted follow ups with third party carriers for insurance claims
- Handled incoming and outgoing mail, scanning, and indexing documents and handling any other tasks that are assigned
- Assisted with the development of online learning modules for remote workers.
Leave of Absence Coordinator
Sedgwick
Hilliard, OH
06.2019 - 02.2020
- Established FMLA claims; tracked and coded documentation in accordance with internal workflow processes
- Analyzed FMLA claims to determine eligibility and certification in compliance with state and federal regulations
- Identified action plan; determined benefits due; and made timely case decisions based on service expectations as established by the client
- Upheld confidentiality regarding protected health information and adhere to HIPPA regulation
Claims Processor
Nationwide Insurance Company
Columbus, OH
03.2020 - 10.2020
- Reviewed and determined payment of minor, undisputed and/or limited authorization claims
- Verified coverage and damage reports received from vendors and customers for accuracy and consistency with the claim as reported
- Audited bills for detection of possible fraud; refers findings to Special Investigations Unit as advised
Process Administrator
Huntington National Bank
Columbus, OH
04.2021 - 10.2022
- Communicated with customers and vendors in person and via telephone to answer questions, process transactions and resolve issues
- Maintained fast-paced schedule by consistently providing satisfactory application approval turnaround times
- Inspected loan package documentation to spot suspicious or fraudulent documentation
- Create and implemented administrative processes and procedures to prioritize job tasks and establish personnel responsibilities.
Claims Specialist- WCCS Deployed
State Farm
Columbus , OH
12.2023 - Current
- Review and analyze homeowner's claims to determine validity, completeness, accuracy, and eligibility
- First point of contact to meet with our insureds, explain coverage, estimate damages, and help them through the claims process
- Handling homeowners, commercial and large loss claims from natural disasters and/or weather-related events
- Coordinate and plan investigations of claims to confirm compensability and coverage
Education
Bachelor of Science - Financial Management
Franklin University
Columbus, OH12-2019
High School Diploma -
Licking Heights High School
Pataskala, OH2015
Skills
- Active listening
- Critical thinking
- Problem solving
- Adaptability
- Time management
- Relationship building
- Resourceful
- Interpersonal skills
- Decision Making
- Proficient in MS Excel, OneNote, Powerpoint, Sharepoint, Word, Teams
Professional References
Diahann Armstrong
WCCS Deployed Trainer
State Farm
Phone# 312-515-1629
diahann.armstrong.j7mw@statefarm.com
Angel Armendariz
Claims Team Manager
State Farm
Phone# 309-831-8278
angel.armendariz.ruvf@statefarm.com
Chris Becket
Claims Team Manager
State Farm
Phone# 312-502-6216
chris.becket.hmxh@statefarm.com
Timeline
Claims Specialist- WCCS Deployed
State Farm
12.2023 - Current
Process Administrator
Huntington National Bank
04.2021 - 10.2022
Claims Processor
Nationwide Insurance Company
03.2020 - 10.2020
Leave of Absence Coordinator
Sedgwick
06.2019 - 02.2020
Health Claims Assistant
Sedgwick
11.2018 - 06.2019
Service Center Representative
Sedgwick
04.2018 - 11.2018
Data Migration Specialist
ComResource
01.2018 - 05.2018
Customer Service Representative
HKT Teleservices
11.2016 - 03.2017
Bachelor of Science - Financial Management
Franklin University
High School Diploma -
Licking Heights High School
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